TOPLINE

Laparoscopic sleeve gastrectomy (LSG) with concomitant hiatal hernia repair was associated with acceptable long-term outcomes. Postoperative gastroesophageal reflux disease (GERD) was strongly associated with hernia recurrence. Among patients who underwent reoperation, symptomatic GERD was a more frequent indication than anatomic hernia recurrence.

METHODOLOGY

• Despite the widespread adoption of concomitant hiatal hernia repair during LSG, long-term data beyond 5 years are scarce, and the clinical significance of hernia recurrence remains unclear.
• Researchers conducted a retrospective cohort study of 108 patients (mean age, 50.1 years; 80.6% women; mean preoperative BMI, 42.7) who underwent LSG plus hiatal hernia repair at four Italian bariatric centers between 2014 and 2015.
• The majority of hiatal hernias were of the sliding type (98.2%), and large hernias (≥ 5 cm) were present in 10.2% of patients. Posterior cruroplasty was the standard repair technique.
• The primary outcome was anatomic hernia recurrence, defined as transhiatal migration of the gastric sleeve by more than 2 cm on endoscopy or radiography, and secondary outcomes included the time to hernia recurrence, predictors of recurrence, and reintervention rates and indications.
• Patients were followed regularly after surgery and annually after 2 years. The median follow-up period was 90 months.

TAKEAWAY

• Hernia recurrence occurred in 13.0% (n = 14) of the patients, with a median time to recurrence of 80.5 months. Freedom from recurrence was estimated at 98.1% at 5 years and 68.9% at 10 years, although the 10-year estimate should be interpreted cautiously.
• Of the 14 patients with hernia recurrence, five required surgical reintervention, while nine were managed conservatively. In total, 11 patients underwent reoperation, with six procedures performed for refractory GERD and five for recurrent hernia.
• Postoperative GERD and hernia recurrence were closely linked: Most patients with recurrence had reflux symptoms (64.3%), and recurrence was also more common among patients with postoperative GERD than among those without (26.5% vs 6.8%).
• In the adjusted analysis, both large hernias and postoperative GERD were strong predictors of hernia recurrence (adjusted odds ratio [aOR], 6.41; P = .027 and aOR, 6.37; P = .006, respectively).

IN PRACTICE

“These findings suggest that reflux-related symptoms may represent an important marker of clinically meaningful failure, beyond anatomical recurrence alone, although the direction of this association remains uncertain,” the authors of the study wrote.

SOURCE

The study was led by Francesco Maria Carrano, Sant’Andrea Hospital, Sapienza University of Rome, Rome, Italy. It was published online in Obesity Surgery.

LIMITATIONS

The primary analysis used a complete-case approach, including only patients with documented recurrence status at follow-up. For many patients, recurrence was determined from clinical visits rather than standardized imaging. In addition, objective reflux testing with pH-impedance monitoring and manometry was not routinely available. The relatively small number of recurrence events limits the robustness of predictor analyses, and associations in regression models should be interpreted cautiously.

DISCLOSURES

Open-access funding was provided by Sapienza University of Rome within the CRUI-CARE agreement. The authors disclosed having no competing interests.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.